Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference.

OBJECTIVE: Critically ill patients are at high risk of malnutrition. Insufficient nutritional support still remains a widespread problem despite guidelines. The aim of this study was to measure the clinical impact of a two-step interdisciplinary quality nutrition program. DESIGN: Prospective interventional study over three periods (A, baseline; B and C, intervention periods). SETTING: Mixed intensive care unit within a university hospital. PATIENTS: Five hundred seventy-two patients (age 59 ± 17 yrs) requiring >72 hrs of intensive care unit treatment. INTERVENTION: Two-step quality program: 1) bottom-up implementation of feeding guideline; and 2) additional presence of an intensive care unit dietitian. The nutrition protocol was based on the European guidelines. MEASUREMENTS AND MAIN RESULTS: Anthropometric data, intensive care unit severity scores, energy delivery, and cumulated energy balance (daily, day 7, and discharge), feeding route (enteral, parenteral, combined, none-oral), length of intensive care unit and hospital stay, and mortality were collected. Altogether 5800 intensive care unit days were analyzed. Patients in period A were healthier with lower Simplified Acute Physiologic Scale and proportion of "rapidly fatal" McCabe scores. Energy delivery and balance increased gradually: impact was particularly marked on cumulated energy deficit on day 7 which improved from -5870 kcal to -3950 kcal (p < .001). Feeding technique changed significantly with progressive increase of days with nutrition therapy (A: 59% days, B: 69%, C: 71%, p < .001), use of enteral nutrition increased from A to B (stable in C), and days on combined and parenteral nutrition increased progressively. Oral energy intakes were low (mean: 385 kcal*day, 6 kcal*kg*day ). Hospital mortality increased with severity of condition in periods B and C. CONCLUSION: A bottom-up protocol improved nutritional support. The presence of the intensive care unit dietitian provided significant additional progression, which were related to early introduction and route of feeding, and which achieved overall better early energy balance.

Cultivo in vitro de cana-de-açúcar exposta a diferentes fontes de luz

O objetivo deste trabalho foi avaliar o efeito de diferentes comprimentos de onda no desenvolvimento in vitro de mudas de cana-de-açúcar. Explantes foram submetidos a quatro tratamentos de diodos emissores de luz (LED): 100% azul; 70% azul + 30% vermelha; 30% azul + 70% vermelha; 100% vermelha, além do controle com lâmpada fluorescente branca. As plântulas foram avaliadas quanto a: número de brotações; altura; massa de matéria fresca e seca; e conteúdo de carotenoides e das clorofilas a e b. Observou-se desmanche dos tilacoides nos cloroplastos, proporcional ao aumento na incidência de luz vermelha. O porte das mudas diminui com o aumento na incidência de luz vermelha.

Manejo de lepidópteros-praga na cultura do milho com o evento Bt piramidado Cry1A.105 e Cry2Ab2

O objetivo deste trabalho foi avaliar a eficácia do evento piramidado (MON 89034), que expressa as proteínas Cry1A.105 e Cry2Ab2, no controle dos principais lepidópteros-praga da cultura do milho no Brasil, Spodoptera frugiperda, Helicoverpa spp. e Diatraea saccharalis. Os ensaios foram conduzidos em quatro regiões do país, com o híbrido DKB 390, submetido a seis tratamentos: híbrido com o evento piramidado, híbrido com o evento que expressa apenas a proteína Cry1A(b) (MON 810) e híbrido convencional (não Bt), todos com e sem manejo integrado de S. frugiperda. Para o evento piramidado, não foi necessário o controle químico em nenhum dos locais avaliados. Diferenças significativas foram observadas entre os tratamentos quanto aos danos e à presença de lagartas. Em geral, essas variáveis foram mais baixas no híbrido com o evento piramidado e mais altas no híbrido convencional, sem controle químico. Sob alta infestação, o controle químico reduziu os danos causados por S. frugiperda e D. saccharalis, tanto no evento que expressa apenas uma proteína, como no híbrido convencional. Com base nos danos causados pelos insetos, o evento piramidado Cry1A.105 e Cry2Ab2 é eficiente no controle dos principais lepidópteros-pragas do milho no Brasil.

Optical evidence for the proximity to a spin-density-wave metallic state in Na0.7CoO2

We present the optical properties of Na0.7CoO2 single crystals, measured over a broad spectral range as a function of temperature (T). The capability to cover the energy range from the far-infrared up to the ultraviolet allows us to perform reliable Kramers-Kronig transformation, in order to obtain the absorption spectrum (i.e., the complex optical conductivity). To the complex optical conductivity we apply the generalized Drude model, extracting the frequency dependence of the scattering rate (Gamma) and effective mass (m*) of the itinerant charge carriers. We find that Gamma(omega) at low temperatures and for similar to omega. This suggests that Na0.7CoO2 is at the verge of a spin-density-wave metallic phase.

Ground-state order and spin-lattice coupling in tetrahedral spin systems Cu2Te2O5X2 (X = Br or Cl)

High-resolution ac susceptibility and thermal conductivity measurement on Cu2Te2O5X2 (X=Br,Cl) single crystals are reported. For Br-sample, sample dependence prevents one from distinguishing between possibilities of magnetically ordered and spin-singlet ground states. In Cl-sample a three-dimensional transition at 18.5 K is accompanied by almost isotropic behavior of susceptibility and almost switching behavior of thermal conductivity. Thermal conductivity studies suggest the presence of a tremendous spin-lattice coupling characterizing Cl- but not Br-sample. Below the transition Cl-sample is in a complex magnetic state involving AF order but also the elements consistent with the presence of a gap in the excitation spectrum.

L'hypnose intégrée aux soins de patients brûlés: impact sur le niveau de stress de l'equipe soignante [Hypnosis integrated in burn care: impact on the healthcare team's stress].

Hypnosis for burn care was introduced in 2004 in the CHUV burn center showing great benefit for burned patients. Whereas advantages of hypnosis for the patient are well established, the impact on the medical staff remains poorly assessed. This manuscrit reviews current attested benefits of hypnosis for patients, specially for burned patients. The results of a recent study assessing the impact of hypnosis on the staffs level of stress caused by burn treatment, will also be introduced.

Delayed contrast-enhanced MRI of the coronary artery wall in takayasu arteritis.

BACKGROUND: Takayasu arteritis (TA) is a rare form of chronic inflammatory granulomatous arteritis of the aorta and its major branches. Late gadolinium enhancement (LGE) with magnetic resonance imaging (MRI) has demonstrated its value for the detection of vessel wall alterations in TA. The aim of this study was to assess LGE of the coronary artery wall in patients with TA compared to patients with stable CAD. METHODS: We enrolled 9 patients (8 female, average age 46±13 years) with proven TA. In the CAD group 9 patients participated (8 male, average age 65±10 years). Studies were performed on a commercial 3T whole-body MR imaging system (Achieva; Philips, Best, The Netherlands) using a 3D inversion prepared navigator gated spoiled gradient-echo sequence, which was repeated 34-45 minutes after low-dose gadolinium administration. RESULTS: No coronary vessel wall enhancement was observed prior to contrast in either group. Post contrast, coronary LGE on IR scans was detected in 28 of 50 segments (56%) seen on T2-Prep scans in TA and in 25 of 57 segments (44%) in CAD patients. LGE quantitative assessment of coronary artery vessel wall CNR post contrast revealed no significant differences between the two groups (CNR in TA: 6.0±2.4 and 7.3±2.5 in CAD; p = 0.474). CONCLUSION: Our findings suggest that LGE of the coronary artery wall seems to be common in patients with TA and similarly pronounced as in CAD patients. The observed coronary LGE seems to be rather unspecific, and differentiation between coronary vessel wall fibrosis and inflammation still remains unclear.

Population specific and up to date cardiovascular risk charts can be efficiently obtained with record linkage of routine and observational data.

BACKGROUND: Only few countries have cohorts enabling specific and up-to-date cardiovascular disease (CVD) risk estimation. Individual risk assessment based on study samples that differ too much from the target population could jeopardize the benefit of risk charts in general practice. Our aim was to provide up-to-date and valid CVD risk estimation for a Swiss population using a novel record linkage approach. METHODS: Anonymous record linkage was used to follow-up (for mortality, until 2008) 9,853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CVD) study of 1983-92. The linkage success was 97.8%, loss to follow-up 1990-2000 was 4.7%. Based on the ESC SCORE methodology (Weibull regression), we used age, sex, blood pressure, smoking, and cholesterol to generate three models. We compared the 1) original SCORE model with a 2) recalibrated and a 3) new model using the Brier score (BS) and cross-validation. RESULTS: Based on the cross-validated BS, the new model (BS = 14107×10(-6)) was somewhat more appropriate for risk estimation than the original (BS = 14190×10(-6)) and the recalibrated (BS = 14172×10(-6)) model. Particularly at younger age, derived absolute risks were consistently lower than those from the original and the recalibrated model which was mainly due to a smaller impact of total cholesterol. CONCLUSION: Using record linkage of observational and routine data is an efficient procedure to obtain valid and up-to-date CVD risk estimates for a specific population.

UTILIZACION DE ISOENZIMAS DE EXTRACTOS DE HOJAS EN LA CARACTERIZACION DE CULTIVARES DE DURAZNERO (Prunus persica (L) Batsch)

La caracterización de cultivares de duraznero (Prunus persica (L) Batsch) se hace por medio de la descripción de caracteres agronómicos y morfológicos codificados por organizaciones internacionales, los cuales están fuertemente influenciados por el ambiente. Se han buscado métodos alternativos de caracterización y las isoenzimas han sido utilizadas por su independencia de las condiciones del ambiente, además de identificar individuos en etapas tempranas de su desarrollo. El objetivo del presente estudio es caracterizar cultivares de duraznero mediante el análisis isoenzimático de catecol oxidasas, fosfatasas ácidas, esterazas y peroxidazos en extractos de hojas. Los cultivares de duraznero analizados presentaron bajo polimorfismo isoenzimático, las esterazas caracterizaron diez cultivares, las catecol oxidasas un cultivar agrupándose el resto en cinco modelos, las fosfatasas ácidas caracterizaron dos cultivares agrupándose los otros en siete modelos y las peroxidazos formaron tres grupos. Ello puede explicarse ya que el duraznero es una especie autofértil y presenta una base genética muy reducida. Los evidentes límites discriminatorios de este tipo de análisis hacen que su aporte sea sólo complementario a los métodos de los caracteres agronómicos y morfológicos.

Equilibration and disequilibration between monazite and garnet: indication from phase-composition and quantitative texture analysis

The integration of information which can be gained from accessory [i.e. age (t)] and rock-forming minerals [i.e. temperature (T) and pressure (P)] requires a more profound understanding of the equilibration kinetics during metamorphic processes. This paper presents an approach comparing conventional P-T estimate from equilibrated assemblages of rock-forming minerals with temperature data derived from yttrium-garnet-monazite (YGM) and yttrium-garnet-xenotime (YGX) geothermometry. Such a comparison provides an initial indication on differences between equilibration of major and trace elements. Regarding this purpose, two migmatites, two polycyclic and one monocyclic gneiss from the Central Alps (Switzerland, northern Italy) were investigated. While the polycyclic samples exhibit trace-element equilibration between monazite and garnet grains assigned to the same metamorphic event, there are relics of monazite and garnet obviously surviving independent of their textural position. These observations suggest that surface processes dominate transport processes during equilibration of those samples. The monocyclic gneiss, on the contrary, displays rare isolated monazite with equilibration of all elements, despite comparably large transport distances. With a nearly linear crystal-size distribution of the garnet grain population, growth kinetics, related to the major elements, were likely surface-controlled in this sample. In contrast to these completely equilibrated examples, the migmatites indicate disequilibrium between garnet and monazite with a change in REE patterns on garnet transects. The cause for this disequilibrium may be related to a potential disequilibrium initiated by a changing bulk chemistry during melt segregation. While migmatite environments are expected to support high transport rates (i.e. high temperatures and melt presence), the evolution of equilibration in migmatites is additionaly related to change in chemistry. As a key finding, surface-controlled equilibration kinetics seem to dominate transport-controlled processes in the investigated samples. This may be decisive information towards the understanding of age data derived from monazite.